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FA early

FA late

This is a 59-year-old white male who reported excellent visual acuity immediately after phacoemulsification cataract extraction with implantation of a posterior chamber intraocular lens, but subsequently suffered a rapid deterioration of vision.  At the time of his referral to a retina specialist, his vision had dropped to 20/200 with bothersome metamorphopsias.  Funduscopic photos and fluorescein angiography from that clinic visit are depicted above:

1.	What best explains the findings on fluorescein angiography?
	a. leakage of retinal microcapillaries b. post-operative macular edema c. multiple breaks in the retinal pigment epithelium d.  multifocal/diffuse choroidal neovascular membranes e. photographic artifact
2.	What finding is NOT in keeping with a diagnosis of central serous chorioretinopathy?
	a. male gender b. history of steroid use c. “type A” personality; history of recent stress d.  elevated cortisol levels; Cushing’s Disease e. age of patient (59)
3.	If this patient was darkly-pigmented and had NO history of steroid use, trauma, or surgery, what diagnosis might you suspect?
	a. sympathetic ophthalmia b. Harada’s disease c. age-related macular degeneration d.  parafoveal telangiectasias e. cystoid macular edema
4.	What is the best INITIAL course of action?
	a. observation only b. discontinue steroids and observe c. immediate laser treatment d.  re-operation, including removal of IOL e. initiate topical NSAIDs

For answers to the above, click here on or after April 24, 2007.